Is the pandemic over? It’s complicated

Photo of Jordan Nathaniel Fenster
Kindergartner Arthur Gonzalez competes in a water game during a surprise day of outdoor activities at Old Greenwich School in Old Greenwich, Conn. Wednesday, May 26, 2021. 

Kindergartner Arthur Gonzalez competes in a water game during a surprise day of outdoor activities at Old Greenwich School in Old Greenwich, Conn. Wednesday, May 26, 2021. 

Tyler Sizemore / Hearst Connecticut Media

The coronavirus pandemic is not over yet, experts say, and when it does end it won’t be a hard date but instead a prolonged transition toward recovery.

Rather than a specific, arbitrarily determined end point, the pandemic will die in phases, according to Rick Martinello, Yale New Haven Health’s director of infectious diseases.

A tornado, or a volcano or an earthquake “are all finite incidents that occur at a point in time,” he said. Pandemics cannot really be thought of in that way.

“In emergency management, there are phases of preparedness, response, and then there's a recovery phase,” Martinello said. “So even once it is ‘over,’ it's going to be that transition.”

We may be in that transition period now, from response to recovery, he said. But, if so, “it's not black and white.”

“We don't have clear distinctions of when we're transitioning from one phase of our response into a recovery position,” Martinello said. “It kind of blends because of the prolonged time these events occur over.”

Perception and politics, too, play roles in determining whether or not the world is in the midst of a pandemic. Politicians and the populace, along with the scientific community, will decide when the pandemic ceases to be a concern.

“It's impossible to separate politics from anything that rises to the level of being a national or international health crisis,” Martinello said.

Official declarations

The coronavirus outbreak became an official pandemic when the World Health Organization declared it so on March 11, 2020.

“At some point, there will be a formal declaration that the pandemic is over,” Martinello said.

Regardless of an official declaration, when the pandemic ends is as much a matter of perception as hard, scientific fact, experts say. The consensus is that, to be called a “pandemic,” the outbreak must be widespread on all five continents, which is still the case.

But Martinello said, locally at least, we may be shifting from one phase to another.

“It goes from a pandemic state to this virus being endemic in the human population,” he said, though it may be too early to determine if that’s the case.

Viruses, particularly respiratory viruses, often wax and wane seasonally, and Martinello said “there is concern that when students get back, you know, into the classrooms in September, you know, are we going to see another wave starting.”

“What are we going to see at that point? We don't know,” he said. “And so I think that's one very good reason why it's premature today and tomorrow to declare that this is ‘mission accomplished’ quite yet.”

Kevin Dieckhaus, chief of infectious disease for UConn Health, raised similar concerns. It’s nearly summer now, and Connecticut’s population, both vaccinated and unvaccinated, is spending much of the time outside. Variants are still spreading, and new variants may emerge. There is talk of the need for booster shots, and if people will consent to getting them so soon after the initial vaccine injections.

Nobody knows, Dieckhaus said, what will happen “next fall and next autumn, when we are living in closer quarters.”

Pandemic perception

The human metapneumovirus was first identified in 2001. It is now known to cause respiratory disease in people of all ages. Everyone you know has, most likely, been infected by it.

“Prior to that nobody knew anything about it. It was yet to be discovered,” Martinello said. “After that, as the months went on and people started looking, this virus was not only found everywhere across the globe, but they found evidence that, in some specimens, they could find it from the 1950s.”

The global medical community had, in that case, identified a virus with which everyone had been infected. But Martinello said “we never declared that to be a pandemic, because this virus was just something that was already present, that now was finally described.”

Dieckhaus said “these definitions are more designed to deal with illnesses that have some perception, a manifestation that people are noticing.”

“Epidemics and pandemics are typically diseases that we’re aware of and experiencing,” he said.

The death rate from human metapneumovirus is, of course, far lower than the death rate from the coronavirus. But the issue of when a pandemic begins or ends is, Dieckhaus agreed, something of a philosophical question.

To some degree, the pandemic is over when people collectively decide it’s over. As a culture, we may have decided that the pandemic ended when the CDC lifted the national mask mandate.

“The masking mandates seem to be the quote unquote end,” said Dieckhaus. “In terms of there being a litmus test of ‘pandemic present’ versus ‘pandemic not present,’ it’s much more shades of gray.”

AIDS is another example of a disease that, while never officially declared a pandemic, has widespread transmission and has never been completely overcome, though it has become much more survivable.

“This is a nomenclature issue, and, and there is imprecision here, because we would never refer to HIV as being pandemic 40 years later, but frankly, nothing's changed,” Martinello said. “It's still being transmitted on five continents, and the human population is still not immune to it.”

Among Connecticut residents who are not medical professionals or infectious disease academics, there is some caution.

“I'm not so sure we're out of the woods yet and I'd hate to screw it up now,” said Sue Sweeny of Stamford. “We are at 100 COVID hospitalizations -- same as last September. Anyone remember what happened between last September and now?”

Elinor Pianin of West Hartford would agree. “Not by a long shot,” she said. “Just spoke to a friend yesterday and I said, ‘What is in store come flu season?’ People are too anxious to declare a holiday.”

Danbury’s Michael Thompson said, “My thoughts are yes, generally,” when asked if the pandemic was over, though he did offer a qualification. “COVID is surely not. I think it will be with us forever, which is why it's so important for everyone to be vaccinated.”

Global vs. local

Lyn Burr Brignoli lives in Greenwich, but she often spends a lot of time in Ghana, where she also feels “totally at home.” Brignoli is fully vaccinated, but has postponed a planned trip back to Africa because of slow vaccination rates.

“In the rural north of Ghana, for example, where I am also totally ‘at home,’ they still have not received the vaccine,” she said. “My Ghanaian friend, Bishop Vincent Sowah Boi Nai in Yendi told me he received one shot, but the government ran out of the vaccine and he doesn’t know when he will receive a second one. The problem is both lack of supply and a wobbly distribution system.”

It is for this reason Brignoli is unwilling to say that the pandemic is over and done.

“I am fairly confident here in my little corner of the world, but I am not complacent,” she said. “COVID-19 will not be over until it is over — for everybody.”

From a technical standpoint, Dieckhaus said metrics will matter in the determination. Hospitalization rates, infection rates, deaths, vaccinations and more will lead academics and politicians to declare, at some point, that the pandemic is officially a thing of the past.

There are enough countries in enough continents still dealing with high infection and hospitalization rates so that Dieckhaus said definitively, “this is not under control yet.”

“In that sense we are not out of the pandemic,” he said, though “our local situation is substantially improved due to high vaccine rates.”

Even locally, though, it’s important to note that COVID is not likely to disappear completely any time soon.

“I don’t think we’re going to make the United States a place with zero transmission, at least for a long time,” Dieckhaus said.

Still, when asked to say definitively whether or not the pandemic was over, neither Martinello not Dieckhaus minced words.

“I wouldn't say it now,” Martinello said. “But yeah, that is going to be what occurs at some point. We put a lot of thought on the front end of, ‘Is a pandemic occurring,’ but it's one of those things that maybe we don't realize it's over until it's in our rear view mirror to an extent.”

Dieckhaus was more blunt. He said “the pandemic is not over,” though “it’s certainly improved.”

“I do think that’s premature,” he said. “You can quote me on that.”